The Prevalence of Chronic Diseases in Primary Care Practice
The Prevalence of Chronic Diseases in Primary Care Practice
Introduction: Multimorbidity (multiple chronic illnesses) greatly affects the delivery of health care and assessment of health care quality. There is a lack of basic epidemiologic data on multimorbidity in the United States. This article addresses the prevalence of 24 chronic illnesses and multimorbidity from primary care practices across the United States.
Methods: This cross-sectional study was conducted in the PPRNet, a practice-based research network among 226 practices in 43 states that maintains a clinical database derived from a common electronic health record. Practices providing data as of October 1, 2011, and their active adult patients comprised the population used for analyses. The prevalence of each chronic illness and multimorbidity were calculated.
Results: Included in these analyses were 148 practices with 667,379 active patients. Median prevalence across practices ranged from 35.8% for hypertension to 0.23% for Parkinson disease, with wide variability among practices for all conditions. Multimorbidity increased steeply with age, leveling off at age 80; overall, 45.2% of patients had more than one chronic illness.
Conclusion: Multimorbidity is a prevalent problem in primary care practice, a finding with implications for health care delivery and payment, quality assessment, and research.
More research is needed for complex patients, specifically those with multiple chronic conditions (multimorbidity). Two thirds of health care costs are spent on patients with more than one chronic condition. Multimorbidity also affects the assessment of health care quality, since practice guidelines for single conditions typically do not incorporate implications of comorbidity.
Efforts to study multimorbidity in the United States are hampered by a lack of current basic epidemiologic data. A recent review revealed that no prevalence studies have been done in US primary care practices and the 4 general population surveys are 11 to 28 years old. A 2005 prevalence study of Medicare beneficiaries, which demonstrated that 20% had ≥2 chronic conditions, was limited by its inclusion of only 6 conditions; a 1999 sample found that 64.7% and 42.9% had ≥2 and ≥3 chronic conditions, respectively.
PPRNet, a national primary care practice-based research network, founded in 1995, now comprises 226 practices in 43 states. The PPRNet database is unique among US practice-based research networks; it is derived from the Practice Partner electronic health record (EHR) (McKesson Corp, San Francisco, CA) used by member practices. The database contains anonymized demographic and clinical data and is updated quarterly through automated data extracts.
In this article we present analyses from the PPRNet database on the prevalence of 24 common chronic diseases, the prevalence of multimorbidity, and the association of multimorbidity with age. To our knowledge, this is the first such report from primary care practices in the United States and is timely given the renewed enthusiasm for invigorating primary care and the importance of caring for patients with multimorbidity in this setting.
Abstract and Introduction
Abstract
Introduction: Multimorbidity (multiple chronic illnesses) greatly affects the delivery of health care and assessment of health care quality. There is a lack of basic epidemiologic data on multimorbidity in the United States. This article addresses the prevalence of 24 chronic illnesses and multimorbidity from primary care practices across the United States.
Methods: This cross-sectional study was conducted in the PPRNet, a practice-based research network among 226 practices in 43 states that maintains a clinical database derived from a common electronic health record. Practices providing data as of October 1, 2011, and their active adult patients comprised the population used for analyses. The prevalence of each chronic illness and multimorbidity were calculated.
Results: Included in these analyses were 148 practices with 667,379 active patients. Median prevalence across practices ranged from 35.8% for hypertension to 0.23% for Parkinson disease, with wide variability among practices for all conditions. Multimorbidity increased steeply with age, leveling off at age 80; overall, 45.2% of patients had more than one chronic illness.
Conclusion: Multimorbidity is a prevalent problem in primary care practice, a finding with implications for health care delivery and payment, quality assessment, and research.
Introduction
More research is needed for complex patients, specifically those with multiple chronic conditions (multimorbidity). Two thirds of health care costs are spent on patients with more than one chronic condition. Multimorbidity also affects the assessment of health care quality, since practice guidelines for single conditions typically do not incorporate implications of comorbidity.
Efforts to study multimorbidity in the United States are hampered by a lack of current basic epidemiologic data. A recent review revealed that no prevalence studies have been done in US primary care practices and the 4 general population surveys are 11 to 28 years old. A 2005 prevalence study of Medicare beneficiaries, which demonstrated that 20% had ≥2 chronic conditions, was limited by its inclusion of only 6 conditions; a 1999 sample found that 64.7% and 42.9% had ≥2 and ≥3 chronic conditions, respectively.
PPRNet, a national primary care practice-based research network, founded in 1995, now comprises 226 practices in 43 states. The PPRNet database is unique among US practice-based research networks; it is derived from the Practice Partner electronic health record (EHR) (McKesson Corp, San Francisco, CA) used by member practices. The database contains anonymized demographic and clinical data and is updated quarterly through automated data extracts.
In this article we present analyses from the PPRNet database on the prevalence of 24 common chronic diseases, the prevalence of multimorbidity, and the association of multimorbidity with age. To our knowledge, this is the first such report from primary care practices in the United States and is timely given the renewed enthusiasm for invigorating primary care and the importance of caring for patients with multimorbidity in this setting.
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